NEW YORK (Reuters) - Three Connecticut doctors billed
Medicare for nearly 24,000 drug tests in 2012 - on just 145
patients. Despite the extraordinary number, Medicare
administrators paid the doctors a total of $1.4 million,
according to a Reuters analysis of government payments to health
providers.

The three physicians stand out in the Medicare data released
last month because they conducted three to four times more drug
tests per patient than any other provider in the country. In
fact, they ordered so many individual tests, their patients
averaged one every other day.

A surge in prescription drug abuse among older Americans has
been accompanied by a big increase in urine and blood tests
nationwide. Part of an effort to detect that abuse, the tests
generate millions of dollars for providers. Medicare, the
government insurance system for the disabled and people 65 years
and older, is footing the bill.

Medicare administrators declined to comment on the doctors'
bills or to say whether they were investigating. But experts in
laboratory billing said the high frequency of tests was
extremely unusual and underscored the need for Medicare to
improve oversight of potentially lucrative drug tests to guard
against billing for unnecessary procedures.

"Those numbers are ridiculously high," said Dr Stuart
Gitlow, acting president of the American Society of Addiction
Medicine. "There is no medical indication I can think of that
would require such frequency of testing. I can't come up with a
scenario at all."

Two of the doctors work together in New London, Connecticut.
The third doctor works in Ellington, about 60 miles away. Two of
the three, contacted by Reuters, denied any wrongdoing, with one
saying he was simply following Medicare's billing rules as he
understood them. The third declined to comment.

Each of the doctors requested only the most expensive and
comprehensive drug test, for as much as $94, rather than the
simpler $19 one. This was done to improve the accuracy of the
results, one said.

"SPIGOT OF MONEY"

Medicare paid medical providers $457 million in 2012 for 16
million tests to detect everything from prescription narcotics
to cocaine and heroin, according to the Reuters analysis.

"In some parts of the country every doctor and his cousin is
hanging out a shingle to do (addiction) treatment. There's a
tailor-made opportunity for ordering a profusion of tests
instead of one," said Bill Mahon, former executive director of
the National Health Care Anti-Fraud Association.

"It's like turning on a spigot of money," he said.

Urine and blood tests are potential areas of fraud and abuse

because guidelines for drug testing are vague, leaving the
frequency of testing to the discretion of the provider. Unlike
private insurance companies, which sometimes dispute charges and
pay providers only when they have vetted a claim, Medicare
almost always pays first and asks questions later.

There is often a legitimate need for such drug tests, to
determine whether an addict has relapsed or to ensure that
patients prescribed painkillers are taking them rather than
selling them.

In 2011, the average number of older Americans misusing or
dependent on prescription pain relievers grew to about 336,000,
up from 132,000 a decade earlier, according to the Substance
Abuse and Mental Health Services Administration.

Urine drug testing first showed up on the radar screen of
Medicare investigators in 2011. Since then the Office of the
Inspector General of Health and Human Services, which oversees
Medicare, has settled three cases in which it charged providers
whose billings for drug tests were deemed excessive.

When Medicare administrators released the payment data for
880,000 healthcare providers last month, officials said they
hoped outside experts would comb through it for possible waste,
fraud, and abuse.

DECIPHERING BILLS

Addiction psychiatrist Erum Shahab of Ellington conducted
8,518 drug tests for 43 Medicare patients in 2012, the Reuters
analysis found. That's an average of 198 per patient and the
most of any Medicare provider in 2012.

Shahab declined to comment on her billing.

Medicare reimbursed her billing number $207,046 for these
tests, which detect multiple classes of drugs. Ninety-five
percent of her Medicare revenue came from the tests.

New London-based Dr Bassam Awwa, who also specializes in
treating addiction, conducted 13,260 drug tests for 90 patients
in 2012, or 147 per patient. That's about three per week for
every patient. Medicare paid his billing number $983,894.

Dr Ammar Traboulsi, who shares an office with Awwa, was paid
for 2,142 drug tests on 12 patients in 2012, or an average 178
tests per patient. Medicare paid his billing number $159,107.

Among the thousands of providers who charged Medicare for
drug tests, the next highest number of tests per patient in 2012
was 50. Excluding the three Connecticut doctors, the median
number per patient nationwide was 1.3.

"We would never do that many drug screenings here, even in
our intensive outpatient treatment center," said Dr Elizabeth
Howell, the director of the Addiction Psychiatry Fellowship
Training Program at the University of Utah Neuropsychiatric
Institute, when Reuters read her the numbers for the three
Connecticut doctors.

"There's a big question mark in my mind about what they're
doing," she said.

It is not possible to tell from the Medicare data how many
providers are fraudulently or wastefully billing for drug tests.
For instance, some physicians may be ordering tests on the vast
majority of their patients, even those with no history of abuse.

Recent court cases, however, hint at the extent of the
problem.

In February, SelfRefind, a chain of addiction treatment
centers in Kentucky, agreed to pay $15.75 million to settle
allegations that they billed Medicare and Medicaid for drug
tests that were medically unnecessary and many times more
expensive than other suitable alternative tests, the Department
of Justice said in a statement.

HOW TO BILL

Doctors Awwa and Traboulsi run a program in which patients
addicted to opioids are given Suboxone, a drug made by Britain's
Reckitt Benckiser as a safer substitute, much as heroin addicts
are weaned off that drug through methadone.

Awwa said the payment numbers for his practice were correct,
but misleading. He conducts drug tests only once a week for
patients in the Suboxone program, not the three times per week
the Medicare data suggest.

But he billed Medicare separately for each drug he tested.
Rather than charging Medicare once to test a patient for
ecstasy, ketamine and bath salts, for instance, Awwa charged the
program three times.

"This is the way we were told to bill," he said. "We are not
doing them artificially to generate revenue."

"If you did one drug, if you did 50 drugs, it should have
been times one," said Melissa Scott, a laboratory billing
consultant.

Awwa said he believed the guideline was effective as of 2013
and since then has charged Medicare for only one test per
patient visit. Medicare has not responded to Reuters' requests
for Awwa's 2013 and 2011 billing data.

Medicare uses an automated procedure to halt payments to
providers who bill multiple times for the same drug test,
according to Rob DeConti, assistant Inspector General of Legal
affairs at the Office of the Inspector General. But providers
can skirt the automated denials by changing the way they submit
their bills.

Awwa said Medicare audited him and found nothing wrong with
his laboratory billing practices. Medicare said it does not
confirm or deny whether it has investigated any provider.